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Community Care Home Volunteer
If you are interested in supporting a community care home and the person dying
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* Indicates required question
Email
*
Your email
Name
Your answer
Street Mailing Address
Your answer
City
Your answer
Zip Code
Your answer
Phone Number
Your answer
Willing to support with in ______ of your zip code
2 miles or less
5 miles or less
10 miles or less
20 miles or less
30 miles or less
60 miles or less
>60 miles
Clear selection
Experience caring for the dying
Your answer
Are you willing to participate in a community deathcare training and continuing education?
Yes
No
Clear selection
Have you supported the death via
MAID
VSED
Neither
Other:
I understand this is a volunteer operation, no monies will be exchanged for offerings .
*
Yes
No
Other:
I am interested in helping with/in
*
Option 1
Lead contact for community care home
Doing home visits for site approval
Lead contact for volunteers
Dropping off supplies to care homes
Care shifts
a role that is most needed.
Other:
Required
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